Hand Cleanliness

ABSTRACT

Among other things, from a wireless device, a command is transmitted to wearable monitors within range of the wireless device to update their states to a non disinfected state of the hands of users of the wearable monitors.

This application is a continuation of U.S. patent application Ser. No.11/415,687, entitled Hand Cleanliness, filed May 1, 2006, which is acontinuation-in-part of U.S. patent application Ser. No. 11/353,746,entitled Hand Cleanliness, filed Feb. 14, 2006, which is acontinuation-in-part of U.S. patent application Ser. No. 11/157,094,entitled Hand Cleanliness, filed Jun. 20, 2005, the contents of all ofwhich are incorporated herein by reference.

BACKGROUND

This description relates to hand cleanliness.

Health care workers, food handlers, and others ought to clean theirhands frequently and thoroughly, but they often don't. Better handcleaning habits can be promoted by governmental regulations, companyrules, social pressure, and technology. Techniques that have beenproposed for improving cleaning habits include the use of specialcleaning agents as well as mechanisms and electronic devices toregulate, monitor, and report on how frequently and how effectivelypeople clean their hands.

SUMMARY

In general, in an aspect, a wearable device includes (a) an indicator toindicate a cleanliness state of a user's hands and (b) a wirelesscommunication element to communicate, with an external device,information that is useful in connection with indicating the cleanlinessstate of the user's hands.

Implementations may include one or more of the following features. Anelement of the apparatus maintains a cleanliness state of the user'shands including a disinfected state and a non-disinfected state. Anelement of the apparatus switches the cleanliness state of the apparatusfrom disinfected to non-disinfected regardless of the actual cleanlinessstate of the user's hands. The indicator is at least one of a visualdisplay, a sounding device, a lamp, or a vibrator. Storage holds dataindicative of the cleanliness state of the user's hands.

In general, in an aspect, at a wearable device, a command is received toswitch states from disinfected to not disinfected, and in response tothe command, an indicator that is perceivable by people in the vicinityof a user of the wearable device, is changed from an indication ofdisinfected to an indication of not disinfected, regardless of theactual cleanliness state of the user's hands. In some implementations,information is transmitted about the cleanliness state of the user'shands to an external device.

In general, in an aspect, tracking is done of the cleanliness states ofthe hands of users of wearable cleanliness monitors at a centrallocation.

In general, in an aspect, from a wireless device, a command istransmitted to wearable monitors within range of the wireless device toupdate their states to a non disinfected state of the hands of users ofthe wearable monitors.

In general, in an aspect, based on successive measurements of aresistance of an element that is sensitive to alcohol vapor, adetermination is made whether the element is in a condition thatdegrades its sensitivity to alcohol vapor, and if so, the element isheated to restore its sensitivity to alcohol vapor.

Implementations may include one or more of the following features. Thecondition comprises the presence of water. The determining is based onwhether a drift of the measurements is different in character from anexpected drift. The element is heated until the condition hasdissipated. The element is used in a test of a level of alcohol vaporemanating from a user's finger.

In general, in an aspect, an alcohol vapor sensing device is combinedwith a display to show information associated with a use or user of thesensing device to determine cleanliness of a user's hands.

Implementations may include one or more of the following features. Thedisplay includes a device in which pixels can be switched from one stateto another state using power and then retain their states after thepower is removed. Storage holds information about the cleanliness of theuser's hands, and a processor causes presentation of the information onthe display.

In general, in an aspect, in response to a measurement of a presence ofalcohol on hands of a user, audibly signaling is done from a device inthe vicinity of the user to other people in the vicinity of the user,the cleanliness state of the user's hands.

Implementations may include one or more of the following features. Thesignaling is different depending on whether the cleanliness state isdisinfected or not disinfected. The signaling includes a distastefulsound. The signaling includes a brief noise repeated at intervals. Thevolume of the noise is increased and/or the intervals are decreased overtime.

In general, in an aspect, a wearable unit includes an alcohol sensor, anindicator of a cleanliness state of a user's hands as determined by thesensor, and a wireless transmitter to send information about thecleanliness state to an external device.

Implementations may include one or more of the following features. Asignaling element, on or off the wearable unit, reports, to people inthe vicinity of the user, the cleanliness state of the user's hands.

In general, in an aspect, hand cleanliness of people is managed within afacility by electronically causing wearable devices worn by the peopleto switch to states representing non disinfection of their handsregardless of actual states of disinfection of the hands of the people.

Implementations may include one or more of the following features. Theswitching of states is caused selectively. The selectivity is based onthe locations of the people within the facility. The selectivity isbased on characteristics of the people or their conduct.

In general, in an aspect, the cleanliness states of hands of people in afacility are monitored using information received electronically frommonitoring devices worn by the people.

Implementations may include one or more of the following features. Themonitoring is done from a central location in communication with themonitoring devices. The cleanliness states of people and groups ofpeople in the facility are reported over time. The locations of thepeople are monitored electronically.

Other advantages and features will become apparent from the followingdescription and from the claims.

DESCRIPTION

FIG. 1 is a perspective view of a badge.

FIGS. 2, 3, and 4 are schematic plan views of three layers of the badge.

FIG. 5 is a sectional side view of a chamber at 5-5 in FIG. 4.

FIG. 6 is a three-dimensional view of a space.

FIG. 7 shows a monitor.

FIG. 8 shows a badge in a badge holder.

FIG. 9 is a schematic view of a campus of buildings.

FIGS. 10 through 13 are outside front, inside front, outside back, andinside back views of a badge.

FIG. 14 is a schematic diagram of a badge.

The system described here can be used for monitoring, encouraging, andmanaging the hand cleanliness of people who work or are otherwisepresent in places where hand cleanliness is important, for example, toreduce the spread of disease or to reduce contamination of products thatare being manufactured or for other purposes. Important purposes of thesystem include encouraging or even enforcing hand cleanliness, reportingcompliance with institutional or governmental requirements for handcleanliness, and permitting the central and institutional control andmanagement of hand cleanliness enforcement and reporting.

As shown in FIG. 1, in some examples, an identification badge 10 worn bya doctor has red and green lights 12, 14, that indicate that her handsare likely to be respectively in a clean (e.g., disinfected, greenlight) condition or in a not clean (e.g., not disinfected, red light)condition. The two lights are controlled by a control circuit (not shownin FIG. 1) based on (a) information derived from an ethanol sensor 16 inthe badge, (b) signals from a timer (also not shown in FIG. 1) thattracks the passage of time after the circuit has determined that thehands are likely to be in a disinfected condition, and (c) the state ofthe logic implemented by the control circuit (also not shown). An LCDdisplay 23 provides displayed information that can include the status ofthe badge, the control circuit, or the sensor; the time; the status ofthe cleanliness of the doctor's hands; and other information.

In addition to providing the disinfection determining function, thebadge 10 can be of a shape and form and can display informationsufficient to serve a conventional function of complying with governmentand institution regulations that require health care workers to carryvisible identification. For example, the badge includes a photograph 17of the doctor, and other information including the doctor's name 19 andidentification number 21. A typical badge could be approximatelycredit-card size.

Because health care workers are required to carry such badges for otherreasons, providing the disinfection determining function within the samebadge make it more likely that the worker will use that function than ifthe function were provided in a separate device that the worker wasexpected to carry separately. In addition, because the badge worn by aworker must be visible to others in the health care environment, thefeature of the badge that indicates whether the user's hands are cleanor unclean will naturally be visible to others. Thus, the worker, merelyby having to wear the badge, will be subjected to social pressure ofpeers, patients, and managers with respect to the cleanliness of theworker's hands. This makes the use of the disinfection determiningfeature of the badge and the improvement of cleanliness habitsself-enforcing. The institution by whom the worker is employed need onlyprovide badges that include those features without directly managing ormonitoring their use.

A pair of electrodes 24, 26 on either side of the sensor is used todetermine when a finger 28 or other part of the hand or other skin hasbeen placed against the sensor. When skin of a finger or other part ofthe hand touches both electrodes, the resistance between them willdecline. By measuring that resistance the control circuit can detect thepresence of a finger.

The badge is used by the doctor in conjunction with disinfecting herhands using cleaners of the kind that include ethanol (for example, theliquid known by the name Purell available from GOJO Industries, Akron,Ohio, and which contains 62% ethyl alcohol). Such cleaners areconsidered to be more effective than soaps and detergents in killingbacteria and viruses and are widely used in health care and otherenvironments. When the ethanol-based cleaner is rubbed on the skin ofthe hands, the ethanol kills the bacteria and viruses. The effect willlast for several hours but eventually wears off. Ethanol is volatile andeventually evaporates from the skin, leaving the possibility (whichincreases over time) that live bacteria and viruses will againcontaminate the skin from the air and from objects that are touched, forexample.

The concentration of ethanol on the skin and the decay of thatconcentration from evaporation tend to determine the onset of subsequentcontamination. In turn, the concentration of ethanol on the skin can beinferred by the concentration of ethanol vapor near the skin. By placingthe skin near an ethanol detector for a short period of time, it ispossible to determine the vapor concentration of ethanol and thus toinfer the ethanol concentration on the skin and the disinfected state ofthe skin. When the current inferred concentration is above a threshold,it is possible to make an assumption about how long the hands willremain disinfected.

The badge can be used in the following way to improve the hand cleaninghabits of the user.

In some simple examples, the badge can be configured to determine anddisplay two different states: disinfected and not disinfected.

Except when the badge has recently enough (say within two or threehours) entered the disinfected state due to a measurement cycle in whichan adequate concentration of ethanol vapor had been sensed, the badgewill assume a default state of the user's skin of not disinfected. Thus,when the badge is first powered on, or reset, or the permitted timesince a prior successful measurement has elapsed, the state becomes notdisinfected. When the state is not disinfected the red light is lit andthe word re-test is displayed on the LCD.

In some implementations, the badge can be made to switch from the notdisinfected state to the disinfected state only by a successful ethanolmeasurement cycle. A successful cycle is one in which a finger or otherpart of the body is held in position over the sensor (touching both ofthe electrodes) for a period that is at least as long as a requiredmeasurement cycle (e.g., 30 seconds or 45 seconds or 60 secondsdepending on the design of the circuit), and the concentration ofethanol vapor that passes from the skin into a measurement chamber ofthe sensor is high enough to permit an inference that the skin isdisinfected.

Thus, when the doctor wipes her hands with the cleaner to disinfectthem, she can then press one of her clean fingers against the sensor 16and the two electrodes 24, 26, for, say, 60 seconds.

Touching of both of the electrodes simultaneously by the finger isdetected by the control circuit which then begins the measurement cycle.The control circuit could start the red and green lamps to flashalternately and to continue to do so as an indication to the user thatthe electrodes are both being touched and that the measurement cycle isproceeding. At the end of the sensing cycle, the control circuitdetermines a level of concentration of ethanol and uses the level todetermine whether the finger, and by inference, the hand of the doctoris disinfected. Each time a measurement cycle has been fully completed,the red and green lights may both be flashed briefly to signal that thecycle has ended and the finger may be removed.

The control circuit continually monitors the electrodes to determinewhen a finger or other skin is touching both of the electrodes. Whenthat event is detected, a measurement cycle count down timer (which isinitialized for the number of seconds needed to complete a measurement)is started. At the beginning of a cycle, a voltage is applied to theheater to begin to heat the sensor element. Initially the heater voltagemay be set to a higher than normal value in order to shorten the initialaction period described below. Then the heater voltage is reduced. Atthe end of the measurement cycle, a measurement voltage is appliedacross the series connection of the measurement cell and the seriesresistor, and the voltage across the series resistor is detected andcompared to a threshold to determine whether the state should be set todisinfected or not disinfected.

When the control circuit determines that the hand is disinfected, thecontrol circuit switches to the disinfected state, lights the green lamp(and turns off the red lamp), and displays the word clean on the LCD. Inaddition, upon the initiation of the disinfected state, the controlcircuit starts a re-test count down timer that is initially set to theperiod during which the skin is expected to remain disinfected (forexample two hours).

If the control circuit is in the disinfected state and the uservoluntarily performs another successful measurement cycle (for example,if, during the two hours after the prior successful measurement, shedisinfects her hands again), the re-test count down timer is reset.

Anyone in the vicinity of the doctor who can see the lights or LCD ismade aware of whether, according to the doctor's use of the badge, thedoctor's hands are disinfected or not. People who find troubling theindication that a person's hands are not disinfected can complain to theperson or to the employer, for example.

During the sensing cycle the doctor must keep her finger against thesensor for at least a certain period of time, say 60 seconds, to givethe sensor and the control circuit time to obtain a good reading. If thedoctor removes her finger before the end of the period, the controlcircuit remains in or switches to the not disinfected state and displaysthe word re-test on the LCD display.

If the doctor holds her finger against the sensor long enough tocomplete the sensing cycle, the results of the sensing cycle aredisplayed on the LCD and by lighting either the red light or the greenlight.

If the sensing cycle ends with a determination that the finger is notdisinfected, the doctor can try again to apply enough of the cleaner toher hands to satisfy the circuit and can test the ethanol concentrationagain. And the cycle can be repeated until the disinfected state isdetermined.

In addition to causing the green light to be illuminated and the LCD toshow clean, successfully completing an ethanol test also causes thecontrol circuit to reset a count down timer (not shown in FIG. 1) to apredetermined period (say, two hours) after which it is assumed that thebenefit of the ethanol treatment has worn off and the doctor's hands areno longer disinfected. When the timer times out at the end of thepredetermined period, the control circuit turns off the green light,lights the red light, and changes the displayed word from clean tore-test. The red light stays on and the word re-test continues to bedisplayed until a successful ethanol test is performed by the doctor.

As shown in FIGS. 2, 3, and 4, the badge 10 can be fabricated byassembling three layers.

A bottom layer 29 (shown schematically in FIG. 2) contains a printedcircuit 31 and components mounted on the circuit. The components includethe sensor element 30 of the sensor, two thin batteries 32, 34, amicroprocessor 36 (an example of the control circuit mentioned earlier),a clock 38 (an example of the timer circuit mentioned earlier that canbe used both for the measurement count-down timer and for the re-testcount-down timer), the two LED lamps 12, 14, and an LCD display device40. The detailed interconnections of the devices mounted on the bottomlayer are not shown in FIG. 2. The control circuit could be, forexample, a PIC microcontroller available from Microchip Technology, Inc.of Chandler, Ariz.

A middle layer (shown schematically in FIG. 3) is thicker than thebottom and top layer and provides physical relief for the componentsmounted on the bottom layer. The patterns shown in FIG. 3 representcutouts 43 or perforations in the middle layer.

A top layer 50 (shown schematically in FIG. 4) includes a non-perforatedand non-printed clear region 52 to permit viewing of the LCD display.Space is left for adding a photograph and other information as show inFIG. 1. A perforated region 54 provides openings for passage of ethanolvapors into the badge and two perforations 56, 58 on opposite sides ofthe perforated region 54 accept the conductive electrodes that are usedto detect the presence of a finger.

As shown in FIG. 5, the arrangement of the three layers in the vicinityof the sensor provides a sensing chamber 56. Ethanol vapors 55 pass fromthe finger 53 through the holes in perforated region 54 (which is shownas narrower than in FIG. 4) and into the chamber. Within the chamber isa tin oxide sensor element 30 (which includes an integral heater). Thesensor element is connected by wire bonded connections 61 to circuitruns 59 on the bottom layer of the badge. The heater heats the vaporswithin the chamber and sensor element measures the concentration ofethanol.

Tin oxide sensors are small, low cost, and relatively low in powerrequirements. An example of a tin oxide ethanol sensor is the Model TGS2620-M available from Figaro USA Inc. of Glenview, Ill., although othersensors available from other vendors could be used.

The sensor includes an integral heater and four connections, two for thesensor element, and two for the heater. By wiring a resistor in serieswith the element and measuring the voltage drop across the resistor, thecontrol circuit can determine the amount of current flowing in theelement and hence the resistance of the element which will vary withethanol concentration.

Tin oxide sensors with heaters are subject to a so-called initial actionthat occurs when the sensors are not energized for a period and then areenergized. The resistance of the sensor drops sharply during an initialperiod of energization, whether gases are present in the surrounding airor not. The longer the period of unenergized storage (up to about 30days), the longer the period of the initial action. Therefore using tinoxide sensors in the badges requires a trade off between powering theiroperation for a period longer than the initial action but not so longthat the energy drain caused by measurement cycles reduces the lifetimeof the battery to an unacceptably short period. Experiments suggest thatif the user keeps her finger in contact with the sensor for at least 20or 30 seconds, the sensing of ethanol then begins to dominate theinitial action and permits detection of the ethanol concentration. Otherapproaches may provide a shorter initial action (such as applying alarger voltage for the first few seconds of operation and then thenormal voltage after that).

The badge provides a simple, effective, portable, and inexpensive way toconfirm that the ethanol treatment has occurred no longer than, say, twohours ago, which likely means that the hands remain disinfected. Noother external equipment is needed. The disinfection condition isapparent to anyone in the vicinity of the doctor, including patients,supervisors, regulators, and peers. The social pressure associated withbeing identified easily as not having disinfected hands is an effectiveway to improve the frequency and thoroughness of cleaning. The systemdoes not force the doctor to comply. Compliance with cleaning rules andpolicies may remain less than perfect using the badges, yet it is likelythat the compliance will improve significantly. Any degree ofimprovement translates into reduced costs and injuries now associatedwith hands that have not been disinfected.

A wide variety of other implementations are within the scope of thefollowing claims.

Although we sometimes have referred to use of the system by a doctor, itis also useful for a wide variety of other people, including otherhealth care workers, clean room workers, and guests, consumers, vendors,employees, and other parties involved in any kind activity in whichcleanliness of the hands or other parts of the body is important.

For example, although a simple matching of a measured ethanolconcentration against a threshold can be used to determine simplywhether the state should be disinfected or not disinfected, it is alsopossible to provide a more complicated analysis of measuredconcentration over time and a comparison of the measured concentrationagainst dynamically selected thresholds.

More than two states would be possible, for example, to denote differentlevels of disinfection or to denote that longer periods of time mayelapse before another measurement is required.

The length of time before a first measurement is considered stale andanother measurement is required need not be based on an estimate of howlong the ethanol on the skin will be effective, but can be based on anarbitrary period such as every hour.

The degree of accuracy and repeatability of the measurement of ethanolconcentration may be traded with the cost and complexity of thecircuitry needed to do the measurements. In some examples, the goal neednot be to assure that the user's hands are thoroughly disinfected at alltimes. Rather, if the system encourages more frequent and more thoroughcleaning to any noticeable degree, great benefits will result. Thus avery simple system may be quite useful and effective even though it mayallow some users to cheat and may fail to determine the state accuratelyat all times.

Additional lights and displayed words may be used for a variety ofpurposes. The approach of the end of the disinfected period could beindicated by a yellow light to alert the user that a cleaning would soonbe needed.

The lights and LCD display could be supplemented with or replaced byaudible alerts for all functions or some of them.

In some examples, not all of the circuitry need be mounted in a singlebadge. Some of the circuitry could be located in a different piece ofequipment. For example, a sensor used in common by many people may bemounted on a wall and convey (say by wireless communication) themeasured concentration of ethanol to the badge, which would thendetermine the state and indicate that state through lights and on theLCD. By separating the two, the badge could be lower cost, the sensorcould be more complex and accurate, and the sensor could be located atplaces where the disinfectant solution is dispensed. Fewer sensors wouldbe needed.

Each badge could itself be split into two components that communicatewith each other wirelessly or by wire. For example, a sensor modulecould be located in the user's pocket, while the badge contains only thelogic circuitry.

The cleaning agent that is being measured need not be limited to ethanolbut could include combinations of ethanol with other materials or othermaterials in the absence of ethanol; an appropriate sensor for the othermaterials would be used.

The badge could include clips, hook and loop fasteners, chains, pins,ribbons, and belt loops, and other devices to hold the badge on theuser.

The device need not take the form of a badge but could be an ID devicethat attaches to a belt, a lapel, any other article of clothing, andother parts of the body including an arm, a leg, or a neck.

Instead of integrating the badge, sensor, and indicators in one unit,the badge could be an already existing badge of the kind used inhospitals, for example, to identify employees. Such badges often includenames, photographs, and magnetic stripes or bar codes that can be swipedon readers. A shown in FIG. 8, the device 80 could take the form of aholder 82 in which the existing badge 84 could be held. The device wouldthen contain all of the other elements except those that appear on thebadge. Arranging for a separate badge and badge holder has a number ofadvantages. The badge can be removed and used and swiped independentlyof the device. The badge can be replaced separately without requiring areplacement of the device electronics. Existing badge equipment andtechnology can continue to be used. In some examples, the badge could bedesigned to couple electronically to the holder using, for example, RFIDtechnology with an RFID element 85 in the badge and an RFID transceiver87 in the holder. When the badge is placed in the holder, the holderrecognizes the identification of the user and other information.

In some examples, the badge, the holder, and the RFID transceiver 87could be arranged differently. For example, the RFID transceiver couldbe located on a different device worn by the user while the badge couldremain mounted on the holder.

The badge could be powered by photovoltaic cells using ambient lightinstead of a battery.

Although two different lights could be used to indicate the disinfectedand not disinfected conditions, a single light that can change colorcould also be used, saving cost and space.

Because the ethanol sensor has a lifetime that is limited by the numberof test cycles, the badge can include a circuit that counts the numberof tests performed and illuminates a warning light or provides someother indicator when the sensor is reaching the end of its useful life.

Other types of ethanol sensors can be used. One such sensor comprises aceramic chip but is considerably more expensive than the sensorsdescribed earlier.

Although ethanol and an ethanol sensor form the basis of some of theexamples described here, other disinfectants (for example, trichlosan)may also be used provided that effective sensors are available for them.

In general, in addition to triggering a change in state of the badgeafter a period elapses, it is also useful to maintain a count of thenumber of times a person has run a test (sometimes called the number oftaps) using the sensor in a given period of time. The badge can containa counter that keeps track of the number of taps and determines thecount per 24 hours. This number can then be reported to the person'semployer or to regulatory agencies as evidence of good cleanlinesspractices in an institution. For reporting purposes, the number ofcounts can be communicated to a reader by RFID technology, or any othercommunication technique.

The sensor and indicators need not be associated with identificationinformation but could be provided in a device the sole purpose of whichis to measure the concentration and provide an indication of it.

The device can be used in non-health care environments in which handcleanliness is important or expected.

In a health-care environment, the device could be used by anyone who isproviding services as well as by patients and their families or friends.

Information about the frequency, timing, and results of measurementsperformed historically by the user can be stored on the badge.

Many additional functions could be added to the badge by increasing thecapacity of its processor, memory, displaying, communications ability,and user inputs features.

In other examples of a cleanliness sensing badge 200, as shown in FIGS.10, 11, 12, 13, and 14, a battery 202, a circuit board 204, a sensor206, a multi-color LED 207, a two-dimensional display 209, and amomentary on switch 208 are mounted within two halves 210, 212 of ahousing. To reduce the chance of contamination of or damage to thecomponents on the inside of the housing, sealing elements can beprovided along the seam between the two halves and at the openings inthe two halves through which each of the LED, the switch, and thedisplay are mounted.

As shown in FIG. 14, the components of the sensing badge include a CPU220 having a flash memory (Microchip part 18F6720) to control (a) thedisplay 209 (Varitronix part COG-ZBD9696-02) through I/O lines 222, (b)an alcohol sensor 224 (Figaro part TGS2620) through control outputs 226,228, and A/D input 230, (c) a piezo speaker 231 through outputs 234,236, (d) the two-color LED 207 through outputs 238, 240, and (e) anexternal EPROM (Microchip part 24FC256) 239 through an I/O bus 242. TheCPU 220 also receives information from the switch 208 and communicatesbidirectionally through a voltage level shifter 244 (Maxim partMax3001E), an RF transceiver 246 (Chipcon part CC2420), a balun circuit248, and an antenna 250 with transponders, base stations, and possiblyother external devices 251. The voltage level shifter shifts the DCvoltage level of signals sent back and forth to the CPU from the 5.0volts level used by the CPU to the 3.3 volts level used by thetransceiver, saving power.

Power for the circuitry is provided by the battery 202 through a DC/DCconverter 252 (Maxim part Max1677) and a voltage regulator 254 (TexasInstruments part TPS77033).

The alcohol sensor 224 includes a sensor element 225 and a heater 227.The resistance of the sensor element changes in the presence of alcoholvapor by an amount that relates to the concentration of the vapor. Bypermitting alcohol vapor from a person's finger to reach the sensor andby using an appropriate test protocol, the relationship of theconcentration of the vapor to a threshold can be determined and used toestablish a disinfected or not disinfected state of a user's hands. Theresistance of the sensor element 225 is measured as an analog voltage atthe A/D input of the CPU. If the sensor element remains dry, theresistance of the element in the absence of alcohol will be subject tovery little drift. However, if the sensor element is exposed to water orwater vapor, the resistance will change substantially. For this reason,in a typical use of the sensor element 225, the heater is energized fora period to dry the sensor element before a measurement is taken. Thus,a time delay must occur from the time when a measurement is desireduntil the time when the measurement is completed.

To eliminate the time required to heat the sensor element at the timewhen a test is to be started, the resistance of the sensor element iscontinually monitored. If the drift in the resistance of the elementoccurs more slowly than a background drift rate, indicating that thesensor element has remained dry, no action is taken and the sensorelement is considered to be in a standby mode. Conversely, if theresistance drift is comparable to what would be expected when watervapor is present at the sensor element, the CPU drives the heater in aheating mode to dry out the sensor element. As soon as the resistancehas returned to the expected dry value, the heater is turned off and thesystem returns to the standby mode.

When the sensor element is in the presence of alcohol vapor, such aswhen a person with disinfected hands places a finger near the monitor,the resistance of the dry sensor element shifts substantially,indicating a presence of alcohol vapor. This causes the CPU to enter atest mode in which a determination is made whether the concentration ofthe vapor exceeds a threshold that indicates disinfected hands. Once thetest is completed and related actions are taken by the CPU in responseto the result, the CPU returns to the dry mode. The heater is driven bythe CPU output through the gate of a transistor 256. To detect theresistance of the sensor element, the CPU drives the sensor elementthrough the gate of a transistor 258 and the voltage level at a node 260is the analog input to the CPU.

In this way, the sensor is always available for a test measurementwithout requiring a heating cycle and the user can perform a test simplyby putting her finger near the sensor element without requiring an onswitch to be activated. Nevertheless, in some implementations, a switchcan be provided that can be pressed by the user to initiate the testmode.

The program used by the CPU to operate in the standby mode, the heatingmode, and the test mode, is stored in the CPUs flash memory, while dataneeded to operate in those modes, data derived from measurements of theresistance of the sensor element, and other information can reside inRAM or external non-volatile EPROM.

The data can be stored in and retrieved from the EPROM by the CPU onbehalf of itself and on behalf of external transponders, base stations,and other devices for a wide variety of purposes. Data can be stored atthe time of manufacture, at the time of registration of a user, duringoperation of the monitor, or at any later time.

The data in the EPROM can include calibration information about theempirical relationship of the resistance of the sensor element to thepresence of different concentrations of water vapor, and of differentconcentrations of alcohol.

The data contained in the EPROM includes calibration data, thresholdvalues, and other data useful in the operation of the alcohol sensor,data about a user of the badge, data used for the LCD display, data todrive the piezo speaker, data derived from measurements of the sensorresistance, historical data about the times and results of measurements,and information useful in communicating with external devices.

The calibration data for the alcohol sensor can include empirical dataor tables that represent the expected resistance of the sensor elementassociated with various levels of water vapor or alcohol. The thresholdvalues could include a threshold value for resistance that indicates thepresence of water vapor, a threshold value that indicates the presenceof alcohol vapor, and a threshold value that indicates that theconcentration of alcohol vapor exceeds a value associated withdisinfected hands. The data for the alcohol sensor can also includeinformation about rates of change of resistance that may be associatedwith the introduction of water vapor or the introduction of alcoholvapor that will enable the CPU to determine when to switch modes amongthe standby mode, the heating mode, and the testing mode. The datastored in the EPROM may also include drift information that indicates anexpected rate of drift of the resistance during standby mode over time,and expected rates of change of resistance when water vapor and alcoholvapor are present. The sensor element has a useful life that may beassociated with the number of testing cycles for which it has been used.The EPROM may store information about the number of expected cycles anda counter that indicates the number of actual cycles.

During operation, data may be stored in the EPROM that includes a recordfor each test performed, including the starting and ending time, thestarting resistance, the ending resistance, an indication of the resultof the test (not disinfected, disinfected, inconclusive), whether thetest result has been reported to an external device, and whether thetest was initiated by pushing the on button or simply by touching thefinger to the badge. The EPROM may also include data useful in perform adiagnostic test of the sensor element by applying a certain voltage andcalculating the resulting resistance values over time.

The algorithm that is stored in the EPROM and run by the CPU withrespect to the sensor element could include the following sequences.During initialization of the badge (e.g., when the badge is firstpowered up), the sensor heater may be powered up to heat the sensorelement. Then the sensor element may be energized to +5 Volts and thevoltage at the A/D input can be read by the CPU. The heater may be kepton until the voltage measurement from the sensor element becomes stable(slope is essentially flat), indicating that the heating mode is done,the sensor element is active and dry, and the badge may enter thestandby mode. The heater and sensor element are then de-energized andthe sensor element is allowed to cool to ambient temperature. Then theheater and sensor element are re-energized for a calibration test. Aftera predetermined test period has elapsed (say, two seconds), the voltagefrom the sensor element is measured and the value is saved as thecalibration reference value indicative of the baseline dry state.

When the on button is pressed, the CPU energizes the heater and sensorelement for a fixed test cycle period (say two seconds). If the measuredvoltage representing the resistance of the sensor element is a certainpercentage (say 20%) higher than the baseline dry state reference value,the CPU determines the presence of enough alcohol to indicatedisinfection. Otherwise the CPU determines no disinfection. In someexamples, instead of de-energizing the alcohol sensor after the initialcalibration, the CPU may power the sensor element continuously (orfrequently but intermittently) and make continuous (or intermittent)measurements of resistance. As an alternative to pushing the on button,when a sharp shift in resistance is detected, the CPU may assume thatthe user has placed her finger near the sensor element and wants toinitiate a test. In addition, if the resistance level changessufficiently to indicate presence of water vapor, the CPU can initiate aheating mode.

To compensate for drift in the sensor, the CPU may periodically measurethe voltage output from the sensor element using the steps described fora button press above. If the measurement reflects only a modest drift inthe sensor resistance, then the CPU would substitute the currentmeasurement for the previously stored one. If the drift were significant(perhaps more than one percent different from the previous measurement),the CPU would enter a recalibration mode using the steps described forthe initial startup.

In addition to running the algorithm that controls calibration, heating,testing, and standby modes, the CPU may run a process, stored in theflash memory of the CPU, that controls communication of the badge withexternal devices.

The communication process may perform a wide variety of functions thatare initiated either by the CPU itself or by the external device.

In one function of the communication process, the CPU continuallywatches for a signal from the transceiver indicating that the badge iswithin communication range of an external device, such as a transponder,a base station, or another device. If so, the CPU may execute a routineto fetch data from the EPROM and communicate it to the external device.The information to be fetched could include the identity of the user ofthe badge, the results of calibrations of the sensor, calibrationvalues, battery life information, the number of tests performed sincethe prior upload, and the results of all of the tests performed in theinterim, including all or selected portions of the data stored. Asexplained below, the CPU may have stored data in the EPROM indicatingthe successive locations in a building or a campus at which the badgehad been recognized by external communicating devices, and the upload ofdata could include the data represent the successive locations. When atest has been performed at one of the locations, the association of thelocation with the test may also be uploaded.

The determination of what data is to be uploaded could be made by theCPU or by the external device to which the data is to be uploaded.

In addition to uploading data from the badge to the external device, insome examples, information and commands may also be downloaded from theexternal device to the badge. The data to be downloaded could includeupdated calibration values, updated threshold values, updatedidentifiers, information to be shown on the display of the badge, arefresh of prior test results and data, and other information. Thecommands could include instructions to turn the badge on, or off, toperform a test and return the results, to upload the test results fromprevious tests, to purge the EPROM of prior test results, to control thelighting of the LEDs or the information shown on the display, to triggerthe speaker, to reconfigure the transceiver, to reboot the CPU, andother commands.

The CPU may continually maintain information about the cleanliness stateof the user that is based on current and historical tests performedeither on the badge or on another device (for example, the results ofalcohol tests performed on a wall mounted tester could be communicatedto the badge and used for that purpose). The badge will switch from thedisinfected state to the non-disinfected state after a predeterminedperiod that can be stored in the EPROM and updated based on empiricaldata about the duration of effectiveness of an alcohol cleaning of thehands.

In addition, the badge can be forced by a command from an externaldevice to switch from a disinfected state to a not disinfected statewhen the badge is in communicating range of the external device. Thisfeature can be used by a manager of a building, a space, or a campus, toenforce a fresh hand cleaning regimen on users at certain locationswhether or not they are currently in a disinfected state.

For this purpose, external devices may be locating in places where thehand cleaning regimen is to be enforced and may continually broadcaststate changing commands to any badges that come within range. Forexample, a transponder may broadcast a “switch to not disinfected state”command constantly or at times when a badge is detected nearby. Inresponse to receiving the command, the badge will switch states andaccordingly, update whatever warning signals correspond to a disinfectedstate may be sent, including switching the LED from green to red,changing a message that is shown on the LCD display, and changing thesound delivered by the speaker. The change in state will stronglyencourage the badge owner to wash his hands and test them in order toswitch the state back to disinfected.

For example, the manager of a facility may want to enforce thecleanliness regimen at all bathrooms in the facility. External devicessuch as transponders can be posted at the entrances to all bathrooms (orto clean rooms in the facility, or to operating rooms), causing thebadge of every person who enters the bathroom to be switched to a notdisinfected state. In order to switch the badge back to disinfected, theuser must wash with alcohol and successfully test her finger. Theenforced regimen can be managed statically, simply by the placement ofthe transponders in desired locations that automatically broadcaststate-switching commands. In some examples, the control of the regimencould be dynamically altered, if the external devices that cause theswitching of the state are in communication with a central controller,for example, through an IP network. In such a system, the centralcontroller could be configured at one time to cause certain selectedtransponders to flip states of badges and at another time to cause adifferent set of selected transponders to flip states of badges.

For example, a hospital administrator may wish to enforce the cleaningregimen in one wing of the hospital on one day and in another wing onanother day. Or the regimen may be enforced during a night shift but notduring a day shift. In some examples, the facility may decide to flipthe states of all badges at all locations at one time.

The external devices may include stand alone devices such astransponders that are passive one-way transmitters of commands, do notreceive any data in return and are not connected to any other devices.In some examples, the external devices could also have two-way datacommunications capabilities and/or could be connected to other devicesthat have additional capabilities. The external devices could bededicated to functions associated with the badges or could be devicesthat have other functions for other purposes.

The external devices could include several kinds in one system includingtransponder, wall-mounted test devices, base stations that would servemultiple transponders, and central stations that would communicatemultiple based stations and/or transponders. The communications amongtransponders, monitors, base stations, and central stations can occurwirelessly or by wired connections and by peer to peer communication orin a client server mode.

In addition to triggering state switches in the badges and communicatingdata about alcohol tests performed in the badges, the monitoring systemcan also track the locations and succession of locations of badgeholders. In some examples, when badges communicate their identifierinformation to external devices the information is passed to a basestation and/or to a central station. In this way, the central stationcan be aware of recent locations and the history of locations of allbadge holders. The cleanliness state of the badge holders can then beassociated with the locations and action can be taken if necessary. Forexample, if a badge holder repeatedly enters bathrooms in the course ofa day but never washes, the administrator of the facility can confrontthe person directly. More generally, the badge state history ofindividuals or groups, or all badge holders can be stored and reported,and analyzed.

Studies of selected groups may be performed. For example, a study canfocus on the cleanliness habits of surgeons as compared to nurses. Forthis purpose the party performing the study can control the flipping ofstates of the badges and record and study information about testing doneby the badge holders over time.

The history of which badge holders were in which locations and in whatcleanliness states when at those locations may be tracked and analyzedand be used to provide useful information associated with specificevents. For example, suppose a patient or other person in a hospitalcontracts an infection that is normally thought to be transmitted bytouching or close proximity. If the patient's room was a locationprotected, for example, by a state-switching transponder, the history ofbadge locations could indicate which health care workers were inproximity of the patient during a period considered to be when theinfection was transmitted. This could enable identifying individuals whomay be carriers of infection for corrective action, for example.Correlation of infections contracted by multiple patients withcleanliness states and locations of badge holders could facilitateidentifying a carrier.

To control the operation of the monitor system, each base station and/oreach central station can include a graphical user interface, forexample, an interface presented in an Internet browser window.

Referring again to FIG. 14, the LCD display 209 can be of a kind thatprovides a stable display even when unpowered. In such a display, poweris required to change the states of the pixels of the display, but oncethe pixels have reached a stable state, they will remain in that stateeven after the power has been removed. Such displays are available in astwo-state “black and white” devices, and it is expected that gray scaleand color LCD panels with the same unpowered stable state feature willsoon be available. One advantage of such a display is that the socialpressure aspect of the system can be brought to bear even if the userattempts to remove the battery or otherwise disable the device. Such adisplay also reduces the use of battery power significantly. Otherfeatures described here (for example, the use of a lower powered 3.3volt transceiver and the ability to operate in a standby mode) alsocontribute to reduced battery load.

The information to be shown on the display could include the name,identifying number, and picture of the user of the badge (based on astored image), the cleanliness state of the user, the history of thecleanliness state, and the state of the badge and its operation. Thedisplayed information could be controlled by the CPU or in part by theuser of the badge, or by the facilities manager.

The communication protocol in some examples is the Zigbee protocol (IEEE802.15.4) which requires relatively low power, operates at 2.4Gigahertz, is license-free, and operates at relatively low telemetryrates.

Referring again to FIGS. 10 through 13, the front of the badge includesa sensor access grid 300 in the form of a round configuration of linearslits that allow alcohol vapors to pass into an enclosed sensor chamber302 formed within the housing. The sensor chamber includes a tubularchannel 304 in which the cylindrical outer wall of the alcohol sensorcan be held with the end face of the sensor aimed in a directionparallel to the front surface of the badge (rather than aimed in thedirection of the sensor access grid). Alcohol vapors can follow the pathof arrow 306 into the chamber 302 where it can touch the sensor elementface of the sensor. Eventually the incoming vapor can exit at rightangles through a vapor exhaust vent 308 on the back half of the housing.The intake grid and the exhaust vent are positioned and oriented so thatforeign materials (water or other liquids, for example) that strike theouter faces of the housing cannot easily reach the surface of andcontaminate the sensor element. Other features of the housing seal theperimeters of the two halves and the holes through which the on switch,the display, and the LED project.

In some examples, instead of (or in addition to) storing the user'sidentity information in the EPROM of the badge, the information (andother information about the user) can be derived using RFID technologyfrom an RFID chip 318 that is part of an existing identification badge316 issued by the facility to the user for other purposes. In theseexamples, the badge could be extended 314 at one end to accommodate thebadge.

The piezo speaker can be used for a wide variety of functions. Onefunction is to provide an audible indication of a cleanliness state ofthe user. By storing appropriate audio clips in the EPROM and playingthem back through the speaker, a happy or upbeat sound could be playedbriefly when a successful test is completed and an unhappy or grumpysound could be played when a test has failed. In the case of a failedtest, the grumpy sound could be repeated at intervals (say severalminutes) and the volume of the sound could be increased and theintervals decreased over time so that the social pressure to wash thehands and conduct a successful test becomes irresistible.

In addition to a display, an LED, and a speaker, the badge could includea vibration element to alert the user when the safe disinfected periodis near an end or has ended, for example.

As shown in FIG. 6, in some examples, a monitor 70 could be mounted on awall 72 of a space 74, such as a bathroom. The monitor could contain aradio frequency transceiver 75 that would cooperate with radio frequencyidentification (RFID) elements contained in badges of users. Using RFIDtechnology, when a person wearing a badge passes near to the monitor,the monitor could use RF communication to determine that the person ispresent and to fetch information from the badge about the person'sidentity (and other information as discussed later). The monitor couldalso send an instruction to the badge to cause the badge to reset itselfto the not disinfected state. Communication technologies other than RFIDcould also be used to detect the presence of the user and to communicateinformation between the monitor and the badge or other elements worn bythe user. The element worn by the user could be one that identifies theuser or one that does not identify the user.

When the person wearing the badge enters the bathroom, or any othermonitored space such as a patient room, or a surgical theater, thetriggering device sends a signal to the badge that causes the badge toenter the not disinfected state and light the lamp that indicates thatstate. This triggering will encourage the user to disinfect his handsbefore leaving the bathroom or before proceeding further into themonitored space in order to avoid the social disapproval associated withleaving the bathroom with the red light on. In these examples, thebadge's state could be forced to change to the not disinfected stateregardless of how much time has passed since the most recent successfultest using the badge sensor. The user's status can be reset to thedisinfected state by the user cleaning his hands and testing them.

As shown in FIG. 7, a hand cleanliness monitor 70 could include not onlyan ethanol or other sensor 106 but also a presence detector 108 and oneor more indicators 110 of hand cleanliness with respect to one or morepeople who have entered the space. One of the indicators 112, whichcould be broadly visible to people in the space (for example, if it isplaced on an interior wall of a room) or people outside the space (forexample, if it is placed on an interior wall of a room) or both, couldturn from green (indicating that all people in the space are believed tohave disinfected hands) to red when a person is detected as entering thespace. In that case, the red light would indicate to viewers that aperson whose hand cleanliness state is unknown and assumed to be notdisinfected has entered the space.

The person entering the room could cause the light to turn from red backto green by touching the sensor (assuming his hands bear enough ethanolto imply a disinfected condition) or by first cleaning his hands andthen touching the sensor.

In some examples, the monitor could be placed on in interior wall of apatient's room. Whenever anyone enters the room, including health careworkers, the patient, or guests, the monitor would indicate a possiblynot disinfected condition until someone touches the sensor and causesthe red light to turn green. Social pressure of people in the room, whowould observe the red light would help to enforce good cleanlinesshabits on every person entering the room.

The parts of the monitor need not be included in a single integratedwall unit. For example, a portion of the monitor that detects that aperson has entered or left a space could be a separate system, includingan existing system, that would exchange the information with the monitoras needed. The indicators could also be located separately from themonitor to make the lights visible to many people even though themonitor is located near an entrance to or exit from a monitored space.The sensor, too, could be located separately from the monitor. Forexample, the badge sensors could provide the re-test information to themonitor.

In some examples, an entire building could be monitored by providingmonitors on the walls at all entrances to the building. In addition tothe social pressure associated with public display of the notdisinfected condition, an employee or automated gate at each entrancecould require that the person entering either prove that his hands aredisinfected by using the sensor either upon entry or after using adisinfectant available at the entrance.

A variety of spaces could be monitored, including bathrooms (or otherlocations where disinfecting is especially important) and changing areasin hospitals or food processing facilities, for example.

In some examples, the monitor could include circuitry that would detect,in other ways than described above) a presence of one or more peoplewithin a space (whether or not the people have entered or left thespace), would determine a cleanliness state of hands of the peopledetected as present, would include circuitry to report the cleanlinessstate.

A publicly viewable monitor used to indicate the disinfected conditionfor people within a space can facilitate social pressure being appliedby people in a room to people who enter the room even without themonitor having any information about the identity of a person enteringthe room. In addition, the monitor may include or be part of a systemthat includes devices to determine who has entered a space and tocorrelate that information with a person who then uses the sensor toindicate that his hands have been disinfected.

For example, the person entering the room may carry a badge (of the kindissued by a health care facility) that uniquely identifies him andincludes a bar code, a magnetic stripe, an RFID element, or anotherdevice that can be read by a reader 114 (for example, the RF transceiver75 in FIG. 6) that is on the monitor or mounted separately on the wall.Depending on the technology, the user's badge could be read from adistance or be swiped on a reader. When the person enters the room, hispresence and identity are detected. At the time when he successfullycompletes a measurement by the sensor indicating that his hands havebeen disinfected, his identity is read again and compared with theidentities of people who have entered the room and not been determinedto have passed a measurement for disinfected hands. Only when all of thepeople who have entered the room have passed the test will the red lightbe switched to green.

An enterprise could issue temporary identification cards to every personwho enters a building or other space and does not already have anidentification badge for use with the system.

A variety of other techniques could be used to identify the personentering a space, including detection of biometric information (such asa voice print or a finger print or a facial print) or requiring a personto enter an identification code on a keypad 116 on the monitor. Theperson could enter the identification both upon entering the room (insome cases as a trigger for a locked door or other entry gate) and uponpassing a disinfection test using the monitor. In some implementations,it may be possible to identify a person using a fingerprint detectiontechnique at the same location on the monitor and at the same time asthe disinfection test is performed. Other techniques could also be usedto assure that a successful test is accurately correlated to anidentifiable person.

The monitor can also include circuitry that keeps track of how manypeople are in the space (for example, by also detecting when someone hasleft the space). When the oldest successful disinfection test (amongtests that number as many as there are people still in the room)occurred more than a predetermined period (say 2 hours) earlier, themonitor can time out and change the green light to red until someone inthe room successfully tests his hands again.

In these examples, and others, it is possible for people to deceive themonitor, for example, by having one person in the room repeatedly testhis hands positively on behalf of other people in the room. However, asindicated earlier, at least in some examples, the social pressureassociated with the public display of the disinfection state of thespace and the shifting of green to red in certain situations, may besufficient to significantly improve the frequency and quality of handcleaning among people in the space.

Other arrangements could be used to reduce the degree and nature of thedeception that may be possible and to increase the ability of amonitoring system to track and report the performance of identifiedpeople or groups of people in maintaining hand cleanliness. Some sucharrangements would use the unique identifiers associated with differentpeople to track their performance.

For example, the wall monitor could include a processor and software totrack individuals who enter and leave a room based on their uniqueidentifiers and correlate the identities with tests that are performedsuccessfully. The monitor could then control the red light and greenlight based on the successful testing of hand cleanliness by eachindividual in the space at least as often as some pre-specified timeperiod (say every two hours). By including a small display 120 on theface of the monitor, the person whose hand cleanliness requiresre-testing can be identified by name or identifier or some otherindicator. In this way, each of the people in the space can be alertedfrom time to time of the need to re-clean, and re-test and everyone inthe space can know who needs to do so.

Such a monitor could be used in conjunction and cooperation with wornbadges, for example, of the kind discussed earlier. For example, usingRFID or wireless or other kinds of communication capability in themonitor and at least some badges, the monitor and the badge couldcommunicate, exchange information, control actions, and make reports,all in a wide variety of ways.

In a simple example, the monitor could cause the light on a badge toswitch from red to green at the same time (or different times) as thelights are switched on the monitor, to indicate to others in the spacewhich person in the space needs to re-clean and re-test. A successfultest performed on the badge can be reported to the monitor for use, forexample, in the same way that a test on the monitor would be used.Conversely, the monitor can report to a badge a successful (orunsuccessful test) performed on the monitor by the owner of the badge.More generally, the badges and monitors in one or more spaces cancontinually be synchronized to store common information about tests bythe owner of the badge and to cause common indications of thecleanliness state of the badge owner to be given by both the monitor andthe badge.

As a person moves around in a building that has more than one monitoredspace, the monitors and the badges will together in that way maintaincurrent information and provide current indications of the cleanlinessstate of the badge owner.

As shown in FIG. 9, although this co-operative maintenance ofinformation and reporting can be done informally and by ad hoc action ofdifferent pairs of badges and monitors over time through a building,additional functions and better performance may be achieved by arrangingfor a portion or all of the monitors 130 in a building 132 or campus ofbuildings 134 to be interconnected by a wired or wireless communicationnetwork on a peer-to-peer basis or with the co-operation or control of acentral server 136 or a distributed set of central servers 136, 138,140. The central server or servers may be servers already used for afacility to provide communication and manage the control of other kindsof devices scattered throughout the facility or the reporting ofinformation from other kinds of devices.

The monitors, the badges, and/or the central server or servers mayinclude memory or mass storage 144 that contains a database 146 or otherorganized information about the permanently or temporarily registeredpeople who have access to a building or space. The database can storeinformation that is associated with individuals and information that isstatistically relate to groups and subgroups of the individuals.

In some implementations, an individual badge can maintain a smalldatabase of information about a complete history of an individual'scleanliness testing beginning at the time when the badge was firstissued, or at some later time. Or a rolling set of data ending at thecurrent time may be kept. The data may catalog every instance when theuser tested the cleanliness of his hands, the result, the time of thetest, and the parameter values that were produced by the sensor in thetesting. When the badge is able to communicate with monitors indifferent spaces or subspaces, the badge database may also track theplaces in which each of the tests was performed, which other people werepresent in the space when the tests were performed, and otherinformation. Information in the badge database can be uploaded to one ormore monitors using the communication links to the monitors, or may beuploaded from the badges directly to a central server using specialbadge readers located in one or more places in the facility.

Each monitor can maintain a database of information using informationfrom badges of people with whom the monitor has interacted andinformation from other monitors in other spaces (for example, contiguousspaces). The database of a monitor could track every time a person hasentered a monitored space and every time she has left the space. Thedata could include the time of entry, the time of exit, the space inwhich the user was most recently monitored, the time between entry intothe space and when a re-test was performed, the results of the re-test,the number of re-tests performed in the room, the identities of otherpeople in the room at the time of re-test, and a wide variety of otherinformation.

If a person leaves a monitored space 131 and enters a monitored space132, the monitors in the two spaces could be arranged to communicate sothat the monitor in space 132 need not require a re-test if a re-testhad been done in space 131 within a pre-specified earlier period.

When the monitors and/or badges are networked with a central server, thecentral server can use information provided from the monitors and/orbadges to track the overall cleanliness testing activity of all of themonitored people in all spaces that are networked.

The central server could maintain a database 134 that could includedetailed historical information and statistical summaries ofinformation. The information could track every time any of the monitoredpeople enters or leaves a monitored space, the number of times and thetimes at which re-testing has been done, the results of each re-test,the routes of the people moving through the building or campus, whetherthe people are wearing their badges, whether they used their badges orthe wall monitors to re-test cleanliness, and a wide variety of otherinformation.

The central server can use software 140 running on the server or serversto analyze information stored in the central database or the databasesof one or more of the badges or the monitors. The analyses can addressthe performance of different groups on cleanliness, the correlation ofcleanliness to location, the correlation of demographics (age, gender,geographic location) with cleanliness, the impact of training,monitoring, and other actions on the cleanliness performance, and timedependent changes by individuals, groups, and subgroups of cleanlinessperformance.

In addition to monitoring and analyzing information about cleanlinessperformance the central service can provide reports that are useful toor required by the party that operates the building or campus, otherinstitutions, liability carriers, and governmental bodies that regulatecertain aspects of the performance of the party and the individualsemployed by the party. For example, governmental agencies may requirehospitals to assure that hospital employees are disinfecting their handsmore often than a certain number of times a day and to report failuresto meet that requirement. Reports may also be given to individuals beingmonitored to groups of individuals, to their supervisors, and to others.Reporting to individuals can be done by email. For example, a doctor whois not disinfecting his hands often enough would periodically be sent anautomatic email urging him to improve his cleanliness practices.

The physical housing used for the monitor could be much smaller than thebadge shown in earlier examples and could be used in other environments.For example, a badge in the form of a ring could be used for a nanny. Atthe end of the day, when the parents of the nanny's charge return home,the ring would immediately indicate whether the nanny had washed herhands at least every two hours during the day.

1. An apparatus comprising a wearable device that includes (a) anindicator to indicate a cleanliness state of a user's hands and (b) awireless communication element to communicate, with an external device,information that is useful in connection with indicating the cleanlinessstate of the user's hands. 2-32. (canceled)